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Shaw B, Chung E, Wellard C, Yoo E, Bennett R, Birks C, Johnston A, Cheah CY, Hamad N, Simpson J, Barraclough A, Ku M, Viiala N, Ratnasingam S, Armytage T, Cochrane T, Chong G, Lee D, Manos K, Keane C, Wallwork S, Opat S, Hawkes EA. Poor outcomes for trial-ineligible patients receiving polatuzumab for relapsed/refractory diffuse large B-cell lymphoma in routine care: An Australian Lymphoma and Related Diseases Registry project. EJHaem 2024; 5:325-332. [PMID: 38633125 PMCID: PMC11020125 DOI: 10.1002/jha2.870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 02/01/2024] [Accepted: 02/06/2024] [Indexed: 04/19/2024]
Abstract
Polatuzumab vedotin (Pola) is an approved therapy in combination with rituximab and bendamustine for relapsed or refractory diffuse large B-cell lymphoma (RR-DLBCL) based on positive results of the landmark phase II randomised G029365 trial. However, trial results for many approved novel therapies in RR-DLBCL have not been replicated in routine care cohorts, as RR-DLBCL patient populations are heterogeneous and trial eligibility is increasingly restrictive. We evaluated outcomes from pola ± bendamustine and rituximab in patients with RR-DLBCL enrolled in a compassionate access program with no alternative treatment options identified via the Australasian Lymphoma and Related Diseases Registry according to their eligibility for the original phase II published study. Of 58 eligible patients, 74% met the criteria deeming them ineligible for the G029365 original study at the time of pola's commencement. Median progression-free survival and overall survival in our cohort were 2.3 and 3.5 months, respectively. In contrast to the landmark trial cohort, more of our patients ceased therapy prior to completion, the majority due to progressive disease and only 8/58 received any subsequent treatment. Dismal outcomes in this Australian real-world population demonstrate trial eligibility is challenging to meet, and newer treatments can be difficult to deliver in routine care. Clinically applicable results from therapeutic studies require trial cohorts to reflect representative clinical populations wherever possible, and more research is required to address the benefit of novel agents in the increasing majority who are ineligible for modern studies.
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Affiliation(s)
- Briony Shaw
- Department of HaematologyMonash HealthClaytonAustralia
- School of Public Health and Preventive Medicine, Monash UniversityMelbourneAustralia
| | - Eliza Chung
- School of Public Health and Preventive Medicine, Monash UniversityMelbourneAustralia
| | - Cameron Wellard
- School of Public Health and Preventive Medicine, Monash UniversityMelbourneAustralia
| | - Edward Yoo
- Department of HaematologySir Charles Gairdner HospitalPerthAustralia
| | - Rory Bennett
- Department of HaematologyPeter MacCallum Cancer CentreMelbourneAustralia
| | | | - Anna Johnston
- Department of Clinical HaematologyRoyal Hobart HospitalHobartAustralia
| | - Chan Y Cheah
- Department of HaematologySir Charles Gairdner HospitalPerthAustralia
- Medical School, University of Western AustraliaNedlandsAustralia
| | - Nada Hamad
- Department of HaematologySt Vincent's HospitalSydneyAustralia
- School of Clinical Medicine, Faculty of Medicine and HealthUNSW SydneyAustralia
- School of MedicineUniversity of Notre Dame AustraliaSydneyAustralia
| | - Jock Simpson
- Department of HaematologyPort Macquarie Base HospitalPort MacquarieAustralia
| | | | - Matthew Ku
- Department of HaematologySt Vincent's HospitalMelbourneAustralia
- Faculty of MedicineUniversity of MelbourneMelbourneAustralia
| | - Nicholas Viiala
- Department of HaematologyLiverpool HospitalSydneyAustralia
- South West Sydney Clinical Campus, School of Clinical Medicine, Faculty of Medicine and HealthUNSW SydneyAustralia
| | - Sumita Ratnasingam
- Department of Clinical HaematologyUniversity Hospital GeelongGeelongAustralia
| | | | - Tara Cochrane
- Department of HaematologyGold Coast University HospitalGold CoastAustralia
- Griffith UniversityGold CoastAustralia
| | - Geoffrey Chong
- Department of Medical OncologyGrampians HealthBallaratAustralia
| | - Denise Lee
- Department of HaematologyEastern HealthMelbourneAustralia
| | - Kate Manos
- Department of HaematologyFlinders Medical CentreAdelaideAustralia
| | - Colm Keane
- Department of HaematologyPrincess Alexandra HospitalBrisbaneAustralia
| | | | - Stephen Opat
- Department of HaematologyMonash HealthClaytonAustralia
- School of Public Health and Preventive Medicine, Monash UniversityMelbourneAustralia
| | - Eliza A. Hawkes
- School of Public Health and Preventive Medicine, Monash UniversityMelbourneAustralia
- Department of Medical Oncology and Clinical HaematologyOlivia Newton‐John Cancer Research Institute at Austin HealthHeidelbergAustralia
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Binkley MS, Flerlage JE, Savage KJ, Akhtar S, Steiner R, Zhang XY, Dickinson M, Prica A, Major A, Hendrickson PG, Hopkins D, Ng A, Casulo C, Baron J, Roberts KB, Al Kendi J, Balogh A, Ricardi U, Torka P, Specht L, De Silva R, Pickard K, Blazin LJ, Henry M, Smith CM, Halperin D, Brady J, Brennan B, Senchenko MA, Reeves M, Hoppe BS, Terezakis S, Talaulikar D, Picardi M, Kirova Y, Fergusson P, Hawkes EA, Lee D, Doo NW, Barraclough A, Cheah CY, Ku M, Hamad N, Mutsando H, Gilbertson M, Marconi T, Viiala N, Maurer MJ, Eichenauer DA, Hoppe RT. International Prognostic Score for Nodular Lymphocyte-Predominant Hodgkin Lymphoma. J Clin Oncol 2024:JCO2301655. [PMID: 38531001 DOI: 10.1200/jco.23.01655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 09/20/2023] [Accepted: 01/11/2024] [Indexed: 03/28/2024] Open
Abstract
PURPOSE Nodular lymphocyte-predominant Hodgkin lymphoma (NLPHL) is a rare cancer, and large international cooperative efforts are needed to evaluate the significance of clinical risk factors and immunoarchitectural patterns (IAPs) for all stages of pediatric and adult patients with NLPHL. METHODS Thirty-eight institutions participated in the Global nLPHL One Working Group retrospective study of NLPHL cases from 1992 to 2021. We measured progression-free survival (PFS), overall survival (OS), transformation rate, and lymphoma-specific death rate. We performed uni- and multivariable (MVA) Cox regression stratified by management to select factors for the lymphocyte-predominant international prognostic score (LP-IPS) validated by five-fold cross-validation. RESULTS We identified 2,243 patients with a median age of 37 years (IQR, 23-51). The median follow-up was 6.3 years (IQR, 3.4-10.8). Most had stage I to II (72.9%) and few B symptoms (9.9%) or splenic involvement (5.4%). IAP was scored for 916 (40.8%). Frontline management included chemotherapy alone (32.4%), combined modality therapy (30.5%), radiotherapy alone (24.0%), observation after excision (4.6%), rituximab alone (4.0%), active surveillance (3.4%), and rituximab and radiotherapy (1.1%). The PFS, OS, transformation, and lymphoma-specific death rates at 10 years were 70.8%, 91.6%, 4.8%, and 3.3%, respectively. On MVA, IAPs were not associated with PFS or OS, but IAP E had higher risk of transformation (hazard ratio [HR], 1.81; P < .05). We developed the LP-IPS with 1 point each for age ≥45 years, stage III-IV, hemoglobin <10.5 g/dL, and splenic involvement. Increasing LP-IPS was significantly associated with worse PFS (HR, 1.52) and OS (HR, 2.31) and increased risk of lymphoma-specific death (HR, 2.63) and transformation (HR, 1.41). CONCLUSION In this comprehensive study of all ages of patients with NLPHL, we develop the LP-IPS to identify high-risk patients and inform upcoming prospective clinical trials evaluating de-escalation of therapy for patients with low LP-IPS scores (<2).
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Affiliation(s)
- Michael Sargent Binkley
- Department of Radiation Oncology, Stanford School of Medicine, Stanford University, Stanford, CA
| | - Jamie E Flerlage
- Department of Oncology, St Jude Children's Research Hospital, Memphis, TN
| | | | - Saad Akhtar
- King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Raphael Steiner
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | - Anca Prica
- Princess Margaret Cancer Centre, Toronto, Canada
| | | | | | - David Hopkins
- Department of Haematology, Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom
| | - Andrea Ng
- Dana-Farber Cancer Institute, Boston, MA
| | | | | | | | | | | | | | - Pallawi Torka
- Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | - Lena Specht
- Copenhagen University Hospital, Copenhagen, Denmark
| | - Ravindu De Silva
- Norfolk and Norwich University Hospital, Norfolk, United Kingdom
| | - Keir Pickard
- Newcastle upon Tyne Hospitals, Newcastle upon Tyne, United Kingdom
| | - Lindsay J Blazin
- Division of Hematology/Oncology, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN
| | | | | | - Daniel Halperin
- University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - Jessica Brady
- Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | | | - Maria Anatolevna Senchenko
- Oncology and Immunology, Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Moscow, Russian Federation
| | - Marie Reeves
- Royal Manchester Children's Hospital, Manchester, United Kingdom
| | - Bradford S Hoppe
- University of Florida, Gainesville, FL
- Mayo Clinic, Jacksonville, FL
| | | | - Dipti Talaulikar
- Canberra Health Services, Canberra, Australia
- College of Health and Medicine, Australian National University, Canberra, Australia
| | - Marco Picardi
- Department of Clinical Medicine and Surgery, AOU Federico II, Naples, Italy
| | | | | | - Eliza A Hawkes
- Olivia Newton-John Cancer Research Centre at Austin Health, Melbourne, Australia
- Lymphoma and Related Diseases Registry, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Denise Lee
- Austin Hospital, Eastern Health, Melbourne, Australia
| | - Nicole Wong Doo
- Lymphoma and Related Diseases Registry, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Department of Haematology, Concord Hospital, Concord Clinical School, University of Sydney, Sydney, Australia
| | | | - Chan Y Cheah
- Department of Haematology, Sir Charles Gairdner Hospital, Perth, Australia
- Medical School, University of Western Australia, Perth, Australia
| | - Matthew Ku
- Department of Haematology, St Vincent's Hospital, Melbourne, Australia
- University of Melbourne, Melbourne, Australia
| | - Nada Hamad
- Department of Haematology, St Vincent's Hospital Sydney, Sydney, Australia
- Faculty of Medicine and Health, School of Clinical Medicine, UNSW Sydney, Sydney, Australia
- School of Medicine, University of Notre Dame, Sydney, Australia
| | - Howard Mutsando
- Faculty of Medicine and Health, School of Clinical Medicine, UNSW Sydney, Sydney, Australia
- University of Queensland Rural Clinical School, Toowoomba, Australia
| | | | | | - Nicholas Viiala
- Department of Haematology, Liverpool Hospital, Liverpool, Australia
- South West Sydney Clinical School, UNSW Medicine, Liverpool, Australia
| | - Matthew J Maurer
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | - Dennis A Eichenauer
- Center for Integrated Oncology Aachen Bonn Cologne Dusseldorf, University Hospital Cologne, German Hodgkin Study Group, Cologne, Germany
| | - Richard T Hoppe
- Department of Radiation Oncology, Stanford School of Medicine, Stanford University, Stanford, CA
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Lo EYW, Viiala N, Catt J, French B. Bronchial artery pseudoaneurysm presenting with hoarseness: Diagnosis and endovascular management. Radiol Case Rep 2022; 17:4018-4020. [PMID: 36039083 PMCID: PMC9418193 DOI: 10.1016/j.radcr.2022.07.087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 07/17/2022] [Accepted: 07/23/2022] [Indexed: 11/17/2022] Open
Abstract
Bronchial artery pseudoaneurysm is a rare entity which is diagnosed radiologically; with or without symptoms. Symptoms of phonation changes with bronchial artery pseudoaneurysm are yet to be reported. This article describes the case of a 56-year-old man who presented with a history of a hoarse voice. This was investigated with computed tomography of his chest which diagnosed a bronchial artery pseudoaneurysm under the arch of the aorta. He was subsequently treated with coil embolization. The original symptoms improved with this intervention. This case highlights the rare presentation of hoarseness of voice in this rare condition.
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Affiliation(s)
- Eric Yu Wei Lo
- Department of Cardiothoracic Surgery, Liverpool Hospital, Elizabeth Street, Liverpool, NSW, 2170, Australia
- Corresponding author.
| | - Nicholas Viiala
- Department of Haematology, Liverpool Hospital, Elizabeth Street, Liverpool, NSW, 2170, Australia
- South Western Sydney Clinical School, University of NSW, Kensington, Australia
| | - Jules Catt
- Department of Interventional Radiology, Liverpool Hospital, Elizabeth Street, Liverpool, NSW, 2170, Australia
| | - Bruce French
- Department of Cardiothoracic Surgery, Liverpool Hospital, Elizabeth Street, Liverpool, NSW, 2170, Australia
- University of Western Sydney, Liverpool, NSW, 2170 Australia
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Ho PJ, Hiwase D, Ramakrishna R, Viiala N, Solterbeck A, Traficante R, Zor E, Gervasio OL, High LM, Ross DM, Bowden DK. Cardiac and hepatic siderosis in myelodysplastic syndrome, thalassemia and diverse causes of transfusion-dependent anemia: the TIMES study. Hemasphere 2019; 3:e224. [PMID: 31723837 PMCID: PMC6746020 DOI: 10.1097/hs9.0000000000000224] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 01/30/2019] [Accepted: 03/20/2019] [Indexed: 01/19/2023] Open
Abstract
Supplemental Digital Content is available in the text The significant morbidity and mortality associated with iron overload can be reduced by effective iron chelation. Magnetic resonance imaging (MRI) provides accurate and reproducible iron load assessment. The aim of this epidemiological study was to assess the prevalence and severity of cardiac and hepatic siderosis by MRI and to evaluate the impact of MRI on clinical management in patients with transfusion-dependent anemia and non-transfusion-dependent thalassemia (NTDT). We enrolled 243 patients with myelodysplastic syndromes (MDS), thalassemia major (TM), NTDT or other chronic anemia. Overall, 10% and 48% had cardiac and hepatic siderosis, respectively. Mean liver iron concentration (LIC) was above target range in all groups; mean myocardial T2∗ was normal. Hepatic siderosis was more prevalent than myocardial siderosis in patients with MDS, occurring in 54.4% and 4.4% of patients, respectively. As also observed in patients with NTDT or other anemia, hepatic siderosis was present in a large proportion of MDS patients who were chelation naïve (57.7%), as well as in patients receiving iron chelation therapy (ICT) (52.4%), despite a lower transfusion load compared with TM. Correlation between LIC and serum ferritin was observed across diseases; however, not all patients requiring ICT could be identified with serum ferritin alone, as serum ferritin underestimated LIC in 4.4% and overestimated LIC in 7.5% of patients. Exploratory analyses showed serum ferritin thresholds for liver siderosis detected by MRI at approximately 300 ng/mL higher in MDS than in TM. Most patients reported low–medium adherence to ICT; MRI assessment led to change in ICT in 46% of evaluable patients, including 52% of MDS patients. Accurate organ iron monitoring by MRI facilitated appropriate initiation of chelation, dose optimization and clinical decision making. Trial registration: ClinicalTrials.gov: NCT01736540.
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Affiliation(s)
- P Joy Ho
- Royal Prince Alfred Hospital, Sydney, Australia.,Sydney Medical School, University of Sydney, Sydney, Australia
| | | | | | | | | | | | - Evren Zor
- Novartis Pharmaceuticals, Sydney, Australia
| | | | | | - David M Ross
- Flinders University and Medical Centre, Adelaide, Australia
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